Members of different racial and ethnic groups use preventive, diagnostic, and therapeutic services at different rates, even when access to care, diagnosis, and severity are the same. This means that disparities in use are emerging from the context of the medical interaction. The effectiveness of doctor-patient communication is known to affect health outcomes, and the evidence suggests that doctors have poorer communication skills with minority patients. This five-year program project will assess the extent to which remediable problems in doctor-patient communication result in racial and ethnic variations in the use of medical services and in health outcomes. The program includes six individual research projects and three cores and has four major objectives: (l) (etiology) to determine whether poor communication during the medical interaction causes racial and ethnic variations in the use of services and in health outcomes; (2) (intervention) to develop and test interventions that will improve communication patterns, with the intent of reducing racial and ethnic disparities in use and outcomes; (3) (information dissemination) to disseminate information to various audiences about racial and ethnic disparities in health care and outcomes, about communication skills, and about this research program, in order to translate research findings into practice as rapidly as possible, and (4) (research capacity-building) to build capacity for research into racial and ethnic disparities by means of a scholars' program that spans secondary school through post-doctoral training. Four of the program's projects incorporate interventions aimed at improving communication behaviors. Conditions addressed are breast cancer screening, atherosclerosis, lung cancer, and osteoarthritis. Beginning in Year 1 the Information Dissemination and Educational/Academic Liaison (IDEAL) Core will hold outreach foes in Houston metropolitan area in order to teach simple techniques that are known to make patients better communicators during the medical interaction. If this program project shows that ineffective doctor- patient communication is an important cause of racial and ethnic disparities in the use of beneficial health services, then interventions that improve communication can be expected to lead to better health outcomes for racial and ethnic minority groups.